Options for atrophic scar (post upper blepharoplasty)?

Question

I had upper blepharoplasty 4 months ago. One side has a long scar, with an indentation on the lateral side. It’s very noticeable in natural daylight - makeup doesn’t help. My surgeon said that the incision would be hidden within the eyelid crease, but it is not. I have a mild case of lagophthalmos on this side, so I’m hesitant to pursue treatments that might worsen it. Could CO2 laser or other options help improve the indentation of the scar without increasing the risk to my eyelid function?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. At this point, my advice is to do nothing but scar management. This would include moisturizer, massage, silicone gel/ointment, and sun protection. The sun protection is the one everyone forgets and they do not do long enough, especially on the face as you have to protect new scars on the face from the sun for up to 12 months. The reason I say this is that scars on the upper lid tend to heal very well with normal support and very rarely do they need any intervention or scar revision by one year. Although I can certainly appreciate your concerns regarding your scar, it is actually healed very well and I think that with some more time and support, the issues will resolve on their own. 
All the best,
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Darryl J. Blinski, MD · Answer

Based on your statement and you having lag op, thus following the surgery at four months, no treatment should be done until the lagopus is improved or corrected. Best to see a oculoplastic or ophthalmologist to treat this. As far as the score, it’s only four months it’s still slightly red so it’s in the early stages of maturation. I would recommend waiting, at least 8 to 9 months before considering any kind of surgical intervention as a revision of the scar etc. Good luck

Options for atrophic scar (post upper blepharoplasty)?

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Options for atrophic scar (post upper blepharoplasty)?

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